Pulmonary Vein Isolation in Obese Compared to Non-Obese Patients: Real-Life Experience from a Large Tertiary Center

Abstract

1. Introduction: Pulmonary vein isolation (PVI) is an established procedure used to achieve rhythm control in atrial fibrillation (AF). In obese patients (pts), in whom AF occurs more frequently, a reduced effectiveness of PVI has been observed. Therefore, this study’s aim was to compare the long-term efficacy of PVI between obese and non-obese patients. 2. Methods: We enrolled 111 consecutive pts with a body mass index (BMI) of >30 kg/m2 undergoing PVI from our large registry. Procedural data and outcomes were compared with a matched group of 115 non-obese PVI pts and the long-term outcomes were analyzed. 3. Results: Overall follow-up duration was 314 patient-years in the obese and 378 patient-years in the non-obese group. The follow-up rate was 71% in the obese and 76% in the non-obese group. In both groups, their AF-characteristics did not differ significantly, while known risk factors were significantly more prevalent in the obese group. Procedural characteristics were similar in both groups. During follow-up, the obese pts demonstrated significant weight loss compared to the non-obese pts, while at the same time, the overall recurrence rate during follow-up did not differ significantly between both groups (obese: 39.2% and non-obese: 43.7%). PVI related and long-term complications were comparable between both groups. In the univariate analysis, obesity was not found to be associated with an increased AF recurrence risk. 4. Conclusion: These real-life data demonstrate that obese pts may not show higher AF recurrence rates after PVI compared to pts with normal body weight. Furthermore, PVI was found to be safe and effective in obese patients; thus, a BMI alone may not be a criterion for refusal of PVI.

Master coach The Consequences Workplace of the Head Nurse's Adherence to Nursing Professional Educational Ethics and Knowledge of Moral Dilemmas at King Abdulaziz Hospital, Makkah, Saudi Arabia

“…The current study finding is consistent with the study of Wolfes et al (2022), who reported that respect interventions are important human resource management practices for preventing mistreatment. However, little is known about what influences the effectiveness of respect training.…”

“…Avoid moral and ethical problems by raising awareness of respect as an essential characteristic of the workplace key areas in need of attention are nurses' compliance with professional values through following of code of ethics and ethical principles. Wolfes et al (2022). reported that the majority of nurses score high on the professional values scale in nursing subscales and reported that all items on the professional values scale in nursing nurses are essential concluding that education in nursing plays a vital role in acquiring and maintaining values The current study found a positive correlation between staff nurses' professional values, awareness of moral and moral issues, and respect (knowledge, self-assessment) among all head nurses at different testing times.…”

Cryoballoon pulmonary vein isolation for atrial fibrillation in obese patients: A non-inferiority analysis

“…A limited number of previous studies aimed at investigating the influence of obesity on atrial fibrillation ablation have been published so far [6] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] and data focusing on PVI efficacy in CMD patients are limited [18] , [19] , [20] , [21] , [40] .…”

“…In the context of AF, on one hand side increasing body mass index (BMI) increases the risk of AF occurrence [5] and on the other hand possibly diminishes efficacy and safety of pulmonary vein isolation (PVI) for AF management. [6] , [7] , [8] , [9] , [10] , [11] , [12] Nevertheless, data are equivocal as some authors have recently reported equivalent efficacy and safety of CBA for PVI in obese patients [13] , [14] , [15] , and there is evidence suggesting adequate rates of sinus rhythm maintenance after PVI in obese patients only with effective weight reduction. [16] , [17] Moreover, patients with diabetes as main CMD have an approximately 35% increased risk of developing AF (particularly with poor glycemic control) [18] and a higher recurrence rate correlating with elevated glycosylated hemoglobin after AF ablation.…”

New Perspectives on Risk Stratification and Treatment in Patients with Atrial Fibrillation: An Analysis of Recent Contributions on the Journal of Cardiovascular Disease and Development

“…Conversely, the procedural success and complication rates were similar in patients with normal, mildly reduced, or mild to moderate reduction in glomerular filtration rate [ 60 ]. A case-control study showed that obese patients did not have higher AF recurrence rates after CA compared to patients with normal body weight, suggesting that body mass index alone may not be a criterion for refusing catheter ablation [ 61 ]. Beyond catheter ablation’s efficacy in arrhythmia recurrences, some recent studies have explored the interesting association between AF and dementia and the possible role of rhythm control strategies in preventing cognitive decline [ 62 , 63 ].…”